tbuckley/cabot-search huggingface dataset:
Abstract 15552: Optimal Virtual Monoenergetic Settings in Spectral Ct With a Dual Layer Detector: Breakthrough in Achieving Best Contrast Between Non Calcified and Calcified Plaques and Lumen in Coronary Arteries
Authors: Nobusada Funabashi, Kazuo Misumi
Journal: Circulation (2022)

Introduction: Non calcified plaque (NCP) in coronary arteries on CT is correlated with occurrence of acute coronary syndromes and coronary artery calcification (CAC) may occasionally be co-existed. CAC induces a blooming artifact, which magnifies the calcification versus its actual size. The CT values of NCP and CAC are influenced by tube kilovoltage (kV). Recent spectral CT with a dual-layer detector can generate CT images at any kiloelectron voltage (keV) (range: 40-200) after ordinary acquisition using virtual monoenergetic settings (VMS). Hypothesis: Using a new spectral CT, we can determine the optimal VMS settings for achieving best contrast between NCP, CAC and the lumen in coronary arteries. Methods: We performed enhanced 128 slice Spectral CT 7500 scans using a dual-layer detector in 42 patients with NCP and CAC on CT (tube voltage: 120 kV). After scanning, VMS images at various keV values were created from the spectral-based images. We measured the mean CT values of NCP and CAC, lumen in left main artery (LMA), and fat tissue around coronary arteries within a 1.0 mm2 circle in the axial images at each keV in early phase with a contrast. Results: Lower keV values were linked to only slightly increased mean CT values of NCP, but markedly increased mean CT values of CAC. The CT values of the lumen in the LMA were markedly increased. Conversely, the CT values of fat tissue were slightly decreased. The greatest differences in mean CT values between NCP and the LMA were observed at 40 keV. However, considering blooming artifact of CAC at 40 keV, the optimal keV for achieving the best contrast between the CT values of NCP and the lumen in the LMA was influenced by age, male sex. Conclusions: The NCP in coronary arteries, CAC, lumen of the LMA, and fat tissue exhibit unique characteristics. When conventional CT rather than spectral CT is used to evaluate the occurrence of NCP, it is necessary to determine the optimal tube voltage based on the age and male sex of the patient, CAC, and lumen of the LMA.
Abstract 203: Exploratory Study Of The Time Course Of Post-arrest Neurologic Injury In A Porcine Model Of Pediatric Cardiac Arrest
Authors: Kumaran Senthil, Abhay Ranganathan, Sarah Piel, Marco M Hefti, Julia C Slovis, Robert A Berg, Todd J Kilbaugh, Ryan W Morgan
Journal: Circulation (2022)

Introduction: In preclinical models, hemodynamic-directed CPR (HD-CPR) mitigates post-arrest neurofunctional impairment and cerebral mitochondrial dysfunction. We aimed to explore the temporal evolution of markers of neurologic injury over five days following cardiac arrest treated with HD-CPR. Methods: Pigs (1-month-old) underwent 7min asphyxia, induction of ventricular fibrillation, 10-20min of HD-CPR (goal SBP 90 mmHg, coronary perfusion pressure 20mmHg), randomization to post-ROSC survival duration (24, 48, 72, 96, 120h; n=3 per group) with standardized post-resuscitation care. Plasma neurofilament light (NFL) and glial fibrillary acidic protein (GFAP) were collected at 0, 6, 24, 48, 72, 96, 120h and compared by mixed effects analysis. At terminal endpoints, cerebral cortical tissue was assessed for: mitochondrial electron transport system function; citrate synthase quantification (mitochondrial mass); immunoblot quantification of mitochondrial dynamic proteins (Opa-1, MFN-2, DRP-1, FIS-1); ELISA for 4-HNE and protein carbonyls (oxidative injury); and neuropathologic examination for IBA-1 (microglial activation) and GFAP (reactive astrocytes), all compared via ANOVA. Results: All animals had swine cerebral performance category score of 1 (grossly normal) by 24h after injury. Plasma NFL was significantly elevated at 24, 48, 72, 96 (p&lt;0.001) and 120h (p=0.009) compared to baseline. No significant differences were identified between time points for GFAP, mitochondrial measures, or neuropathological outcomes. Discussion: Despite grossly normal neurofunctional status, plasma NFL was elevated from baseline at multiple timepoints. No significant temporal differences were identified in other markers of neurologic injury. NFL may be a sensitive marker of mild neurologic injury post-arrest.
Abstract 15790: Severe Renal Impairment on Admission is Associated With Early Cardiac Readmission in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Alexa B Kahn, Rana Al-zakhari, Umair Jangda, tamta Chkhikvadze, MD, Hannah Every, Hajira Basit, Kevin Kemp, Jilmil Raina, Jose Chuquin, Ciril Khorolsky, anuragh trikha, Jung Eun Ha, Panayotis Jusakos, Sunil Saith
Journal: Circulation (2022)

Introduction: Acute Decompensated Heart Failure is one of the most common reasons for hospitalization in the United States. Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure admissions, significant contribution owing to various co-morbidities. The role of kidney impairment on admission and prognostic association with early HFpEF readmission is unclear. Methods: We conducted a retrospective analysis of patients admitted with decompensated HFpEF at a hospital in New York City. Clinical demographics &amp; admission laboratory values collected to classify kidney function, according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula to calculate glomerular filtration rate (GFR). Severe renal impairment (SRI), defined as a GFR less than 15 mL/min/1.73 m 2 . Patients followed for one-year to assess all-cause &amp; cardiac-specific readmission within 30 days &amp; all-cause mortality within one year. Results: A total of 358 patients with HFpEF were studied, 218 (60.8%) were female, 196 (54.6%) with diabetes. There were 82 readmissions (22.9%) within 30 days, 37 (10.3%) due to cardiac-specific causes, 69 (19.3%) who died within one year of hospitalization. There were 47 (13.1%) who met criteria of SRI on admission. No difference in one-year mortality with SRI, compare to normal renal function (38.2% vs. 23.1%, p = 0.416). Patients with SRI were more likely to be readmitted within 30-days for cardiac specific reasons than normal renal function (27.6% vs. 8.5%, p = 0.034), while a borderline significant increase in all-cause readmission (38.2% vs. 23.1%, p = 0.066). Conclusions: Patients with HFpEF &amp; SRI, were more likely to experience readmission within 30 days due to cardiac-specific reasons than patients with normal renal function. These findings may assist in enhancing cardiac-specific prevention strategies in discharge planning.
Abstract 15585: Myocardial Reserve After Milrinone to Predict Right Ventricular Failure After LVAD Implantation
Authors: Maria Poonawalla, Mark N Belkin, Jiho Han, Sara Kalantari, Brian Houston, Sean P Pinney, Ryan J Tedford, Jonathan Grinstein
Journal: Circulation (2022)

Introduction: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is a common complication associated with increased morbidity and mortality. Identifying patients at risk for RVF remains challenging. We sought to assess pre-operative right ventricular myocardial reserve after milrinone loading as a risk predictor for post-LVAD RVF. Methods: Adult patients implanted with LVADs from 2013-2019 at a single center who had right heart catherization with milrinone drug study within 30-days preoperatively were included. In addition to standard hemodynamic variables, pulmonary artery pulsatility index (PAPI), right atrial to pulmonary capillary wedge pressure ratio (RA/PCWP), right ventricular stroke work index (RVSWI), pulmonary vascular resistance index (PVRi), and stroke volume index (SVI) were recorded before and after milrinone bolus (50 mcg/kg over ten minutes). Incidence of RVF defined by MCS-ARC criteria within one-year post LVAD were recorded. Student’s unpaired t-tests were used to compare mean of hemodynamic markers to RVF outcome. Results: A total 34 patients were included; 38% women, 50% African American, 68% had non-ischemic cardiomyopathy, 47% implanted with HeartMate 3 LVAD, 20.5% with HeartMate 2, and 32% with HeartWare HVAD. Final right atrial pressure (RAP) after milrinone was higher in those with post-LVAD RVF (15.5 + 7.8mmHg vs 9.2 + 3.9mmHg, p=0.005), as was final diastolic PA pressure (34.3 + 9.2mmHg vs 25.6 + 7.7mmHg, p=0.006). SVI post-milrinone was numerically higher in those without post-LVAD RVF (32.3 + 9.2 vs 26.0 + 7.9mL/m 2 , p=0.06). Percent change in PAPI (p=0.26), RA/PCWP (p=0.35), RVSWI (p=0.10), or PVRi (p=0.92) after milrinone were not associated with RVF. Conclusions: Persistently elevated RAP and diastolic PA pressure, despite milrinone infusion, are associated with RVF after LVAD implantation. Continued reduction in SVI post milrinone may also identify patients at risk for post-LVAD RVF.
Abstract 15493: The Efficacy of Cardiac Myosin Inhibitors versus Placebo in Patients With Symptomatic Hypertrophic Cardiomyopathy
Authors: Mohammad Yassen, Cameron Burmeister, Khalid Changal
Journal: Circulation (2022)

The Efficacy of Cardiac Myosin Inhibitors Versus Placebo in Patients with Symptomatic Hypertrophic Cardiomyopathy. Introduction: Given the interplay between hypertrophic cardiomyopathy, elevated resting LVOT gradients (≥ 50 mm Hg) and heart failure and cardiovascular death, cardiac myosin inhibitors have recently emerged as a promising novel therapy to improve HCM-related outcomes by regulating myocardial relaxation and contractility, and thereby reducing intracavitary gradients. Methods: We performed a literature search using PubMed, Embase, and Cochrane Library from inception through May 2022 to assess the impact of novel cardiac myosin inhibitors (Mavacamten and Aficamten) on resting and Valsalva LVOT gradients and functional capacity in patients with symptomatic hypertrophic cardiomyopathy. The co-primary outcomes were mean percent change from baseline in resting LVOT gradient and Valsalva LVOT gradient, as well as patients achieving NYHA Class Improvement ≥ 1. Secondary outcomes included mean percent change from baseline NT ProBNP, Troponin I, and LVEF. Results: 4 studies (all randomized-control trials, including 3 Mavacamten-focused and 1 Aficamten-focused trials) involving 463 patients were included in the meta-analysis. Compared to patients receiving placebo, the cardiac myosin inhibitor group demonstrated statistically significant differences in baseline percent change in mean resting LVOT gradient (MD -62.48, CI -65.44, -59.51, p &lt;0.00001) and Valsalva LVOT gradient (MD -54.21, CI -66.05, -42.36, p &lt;0.00001), as well as number of patients achieving NYHA Class Improvement ≥ 1 (OR 3.43, CI 1.90, 6.20, p &lt;0.0001). Regarding secondary outcomes, the intervention group demonstrated statistically significant reductions in meant percent change from baseline in NT-proBNP (MD -69.41, CI-87.06, -51.75, p &lt; 0.00001), Troponin I (MD, -44.19, CI -50.59, -37.78, p &lt; 0.00001), and LVEF (MD -6.31, CI -10.35, -2.27, p = 0.002). Conclusion: The use of cardiac myosin inhibitors in patients with symptomatic hypertrophic cardiomyopathy may confer both clinical and sympatomatic benefits, at the possible expense of LV ejection fraction. Further trials with large sample sizes are needed to confirm our findings.
Abstract 164: Efficacy Of Thoracic Impedance For Ventilation Detection During Continuous Chest Compressions
Authors: Xabier Jaureguibeitia, ELISABETE ARAMENDI, Ahamed H Idris, Henry Wang
Journal: Circulation (2022)

Introduction: Current technologies to identify ventilations during out-of-hospital cardiac arrest (OHCA) are limited. Thoracic impedance (TI) recorded by defibrillator pads can be used to identify ventilations, but these are often obscured by artifacts due to chest compressions (CC) and electrode motion. We tested a novel automatic algorithm to detect ventilations in TI during continuous CC. Methods: We analyzed Philips MRx CPR processed data from Dallas - Fort Worth patients in the Pragmatic Airway Resuscitation Trial. We extracted one-minute TI segments during continuous CC with concurrent capnogram recordings. We applied a novel algorithm to identify ventilation in the TI signal, which combined a) adaptive signal processing to remove CC artifacts, b) a recurrent neural network to discriminate TI fluctuations as ventilations, and c) a quality control stage to anticipate TI segments in which ventilation detection could be defective. We evaluated the performance of the algorithm in detecting ground truth capnogram ventilations in terms of sensitivity (SE), proportion of correctly identified ventilations, and Positive Predictive Value (PPV), proportion of detections corresponding to actual ventilations. Results: We extracted 2,551 one-minute TI segments from 367 OHCA patients; median of 6 (IQR 3-10) minutes per patient. Median patient-wise SE and PPV were 86.5 (IQR 71.6 - 95.1) % and 85.4 (68.3 - 94.7) %, respectively. The quality control was successful at discriminating TI segments by ventilation detection performance (Figure). For the 75% and 50% of data with highest quality estimates, SE improved to 90.6 (76.8 - 96.7) % and 95.5 (87.1 - 100.0) %, respectively, and PPV improved to 89.5 (75.0 - 96.4) % and 94.9 (87.3 - 99.8) %, respectively. Conclusions: We demonstrated the accuracy of an algorithm to detect ventilations using TI during continuous CC. Ventilation detection using TI during continuous CC is feasible.
Abstract 15544: Electrographic Flow Mapping Improves Outcome of Catheter Ablation Procedures for Persistent Atrial Fibrillation
Authors: Rita B Gagyi, Rohit E Bhagwandien, Sip Wijchers, Sing-Chien Yap, Tamas Szili-Torok
Journal: Circulation (2022)

Introduction: Catheter ablation (CA) has been proven to be the most effective treatment strategy in paroxysmal atrial fibrillation (AF), however, it remains challenging due to suboptimal success rates in persistent AF. Existing mapping technologies cannot reliably distinguish active sources in this patient population. Recently, a novel mapping system (electrographic flow mapping, EGF) was developed, using computer vision and optical flow smoothing algorithms to detect and quantify patterns of electrical wavefront propagation in the atria. Hypothesis: We hypothesised that EGF mapping is superior to classical three-dimensional electroanatomic mapping (CARTO) in one-year outcomes of CA for persistent AF. We assessed procedural safety and efficiency too. Methods: The study group included patients with persistent AF undergoing CA using EGF combined with CARTO (group1). Data of group 1 patients were compared with data from pulmonary vein isolation (PVI)-only procedures (group 2) and PVI plus additional empiric substrate ablation procedures (group 3) using CARTO. 12-months outcome as freedom from AF and atrial tachycardia/atrial flutter (AT/AFL), procedural safety and efficiency were analysed too. Results: A total number of 70 consecutive patients were included (mean age 63.9±7.8 years). Thirty-nine patients were included in group 1, 16 patients in group 2) and 15 patients in group 3). Patients in group 1 had fewer AF recurrences compared to group 2 and group 3 at 12 months (23.1% vs. 62.5% vs. 46.7%, p=0.01). There were no differences in AT/AFL recurrence between the study groups (12.8% vs. 18.8% vs. 16.7%, p=0.84). Procedure-related complications were documented in none of the study groups. Procedure times were longer in group 1 (187.2±51.6 vs. 136.3±55.4 vs. 139.6±48.6 min, p&lt;0.01). There were no differences in fluoroscopy use (275.8±172.8 vs. 321.4±254.8 vs. 212.3±127.8 mGy, p=0.27), RF application number (p=0.24) and application duration (p=0.77) between the study groups. Conclusions: Our data suggest that patients treated with combined EGF and CARTO mapping-based CA have less AF recurrences at one-year. The procedure is safe and seems to be a promising treatment alternative for this complex group of patients.
Abstract 15816: Cardiovascular Health Status in Young Adulthood and Incident Diabetes Mellitus by Middle Age: The Coronary Artery Risk Development in Young Adults (Cardia) Study
Authors: Shachi Salvi, Hongyan Ning, Michael Bancks, Mercedes R Carnethon, Donald M Lloyd-Jones
Journal: Circulation (2022)

Background: Data are sparse on the association of cardiovascular health (CVH), and change in CVH, during young adulthood with incidence of diabetes mellitus (DM) by middle age. Methods: We characterized CVH at baseline (Year [Y]0), 1985-1986) in 4916 CARDIA participants (ppts) based on six of the AHA’s Life’s Simple 7 definitions for diet, physical activity, smoking, BMI, lipids, and blood pressure metrics, excluding fasting blood glucose (FBG) data. We created a CVH score ranging from 0 (all poor CVH metrics) to 12 (all ideal) points. We also examined change in CVH score from Y0 to Y7. Incident DM was defined as meeting at least one of the following criteria: HbA1c level ≥6.5%, oral glucose tolerance test ≥200 mg/dL, FBG ≥126, or taking glucose lowering medications. We used Cox models to quantify the association between baseline CVH status and incident DM over 30 years of follow up. Results: At Y0, 46% of ppts were men, 51% Black, and the mean age was 24 years; 22% of ppts had low (0-6 points), 73% had moderate (7-10), and 5% had high (11-12) CVH scores. Of note, FBG levels were similar across CVH strata at baseline. Over 30 years, incident DM occurred in 518 ppts (10.5%). Higher CVH level in young adulthood was associated with lower DM incidence by middle age (Table); ppts with high CVH were at 86% lower and ppts with moderate at 62% lower hazards for DM, compared to ppts with low CVH. Improvement in CVH score from Y0 to Y7 was also associated with lower incidence of DM, even after adjustment for Y0 CVH (Table). There were no significant interactions by race or sex. Results were similar using all 7 CVH metrics (including FBG) in secondary analysis. Conclusions: Higher CVH scores in young adulthood, regardless of baseline glucose levels, are associated with substantially lower risk of incident diabetes mellitus by middle age. Improvements in CVH score over time are also associated with lower risk of diabetes mellitus. Focusing on CVH from early life may assist in reducing risk for diabetes in later life.
Abstract 15611: Impact of Amyloidosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From National Inpatient Sample 2016- 2019
Authors: Abi Watts, Kunal N Patel, Shekhar Vohra, Monil Majmundar, Christian Toquica Gahona, Kavin Raj, ayesha jalal, Keval V Patel, MD, Pratik Patel
Journal: Circulation (2022)

Introduction: Aortic Stenosis (AS) is increasingly recognized as one of the underdiagnosed manifestations of cardiac amyloidosis (CA) and existing literature shows conflicting evidence on the impact of CA on AS. Methods: A retrospective analysis of 2016-2019 NIS was conducted to identify hospitalizations (Age≥18) who underwent TAVR using ICD-10 codes. Existing literature was reviewed to select variables before conducting a univariate screen and balancing between groups with CA vs without CA. Propensity score weights were generated using Doubly robust estimation, and IPTW matching was done. The ATET was calculated by extrapolating propensity weights and using weighted multivariate analysis. Results: Out of 227,200 TAVR, only 245 (1.1%) had a concomitant diagnosis of CA. Hospitalizations with CA had a mean age of 80.49, 71.43% males, 82.98% white, 12.77% black, and others. Analysis total of 3,205 deaths, CA was associated with lower odds of mortality (OR 0.25, p 0.00). Factors associated with increased mortality in TAVR were age, HTN, low household income, elixhauser comorbidity index, mechanical vent &gt;24 hrs, Shock on pressors/device, Pericardial effusion/tamponade, AKI, ESRD on HD, and Acute stroke. Out of 17,590 pacemakers (PPM) implantations, CA was associated with lower odds of getting a PPM (OR 0.13, P 0.00). Factors increasing the risk of getting a PPM were high degree AV block, age, male sex, DM, and ventricular arrhythmias. A total of 4280 acute strokes occurred, and CA was not associated with increased risk following TAVR (OR 0.46, p 0.38). Factors increasing the acute stroke risk after TAVR were age, mechanical vent &gt;24hrs, and anemia. 3460 valve complications occurred, and CA was not associated with increased risk (paravalvular leak, displacement, infection, breakdown, and others) (OR 10.20, p 0.16). A significant risk factor for valve complications after TAVR was the presence of pericardial effusion/tamponade. Conclusions: The presence of CA does not result in poor outcomes in TAVR. Limitations of our study are a small sample, retrospective analysis, and lack of cardiac imaging data. Further studies that eliminate our study's limitations are required to conclusively evaluate the impact of CA in patients who undergo TAVR.
Abstract 256: Temporal Trends In Survival From Sudden Cardiac Arrest Based On Presenting Rhythm: Prospective Study In A Large US Community
Authors: Lauri Holmstrom, Harpriya Chugh, Audrey Uy-Evanado, Chad Sorenson, Jonathan Jui, Kyndaron Reinier, Sumeet S Chugh
Journal: Circulation (2022)

Background: The proportion of non-shockable out-of-hospital sudden cardiac arrest (SCA) (pulseless electrical activity [PEA] and asystole) remains higher than shockable SCA (ventricular fibrillation [VF], ventricular tachycardia [VT]). More recently, survival from non-shockable rhythms may have improved, but there is little data available on temporal trends in the community. Aim: To investigate community-based temporal trends in SCA survival based on presenting rhythm. Methods: We prospectively evaluated survival outcomes for out-of-hospital SCA in the Portland, OR metro area (Pop. approx. 1 million, 2002-2017). Detailed lifetime clinical records were reviewed to only include cases of likely cardiac etiology who were resuscitated by emergency medical services. Results: Of 3,723 SCA cases, 908 (24%) presented with PEA, 1,302 (35%) with asystole, and 1,513 (41%) with VF/VT. The mean age was 68.9±21.8 in PEA, 62.2±21.8 in asystole, and 63.2±15.3 in VF/VT. The proportion of PEA decreased over 4-yr time periods (29.2% in 2002-2005, 24.7% in 2006-2009, 20.4% in 2010-2013, 23.3% in 2014-2017) while the proportion of asystole increased (26.2%, 30.3%, 36.8%, 44.1%); and the proportion of VF/VT decreased over time (44.6%, 45.0%, 42.8%, 32.6%). Survival increased over time for PEA (5.7%, 4.3%, 9.6%, 13.6%; p for trend &lt;0.001) and for VF/VT (27.5%, 29.8%, 37.9%, 36.6%; p for trend &lt;0.001), but not for asystole SCA (1.7%, 1.6%, 4.0%, 2.4%; p for trend 0.37). Bystander CPR increased in all 3 presenting rhythms (p for trend for each rhythm &lt;0.001). In a multivariable model including age, sex and Utstein variables the following were significant determinants of survival: young age, female sex, witnessed arrest, and public location in PEA; young age and witnessed arrest in asystole; young age, female sex, public location, witnessed arrest and bystander CPR in VF/VT. Conclusions: Over a 16-year period, survival outcomes improved for SCA presenting with PEA and VF/VT, but not with asystole. Determinants of survival varied between the 3 presenting rhythms. These findings highlight the beneficial effects of the growing bystander-EMS relationship and the potential for further improvements in outcome with ongoing evaluation and enhancement.